P05 - Understanding Clinician Perspectives of Palliative Care Referral Criteria or Tools with Nursing Home Residents

Objective: To describe the experience of nursing home staff, providers, and palliative care providers with identifying residents appropriate for receiving palliative care.
Design: Qualitative descriptive
Setting and participants: Nursing home staff (n=3), nursing home providers (n=10), and palliative care providers (n=4)
Methods: A semi-structured interview guide was used to elicit experiences identifying residents appropriate to receive palliative care. Interviews were recorded and professionally transcribed. Rapid qualitative analysis was conducted to code data and identify themes.

Results: Four themes emerged reflecting participant descriptions of criteria for palliative care referral for residents: 1) resident health status, 2) uncontrolled symptoms, and 3) resident and/or family support needs. “Barriers to palliative care” and “primary palliative care as a solution” emerged as additional themes. In most cases, participants cited resident health status of serious illness and global indicators of decline as well as uncontrolled symptoms in determining when palliative care was appropriate. Resident and family support needs such as conflicted goals of care and unrealistic expectations were also frequently cited as indications to receive palliative care. Most participants discussed barriers to palliative care in nursing homes, including the workforce challenges in accessing specialist palliative care, the lack of screening tools or defined criteria for identifying residents appropriate for palliative care, and lack of knowledge about palliative care among nursing home staff, residents, and families. Primary palliative care by nursing home providers was identified as one solution to meeting the needs of this vulnerable population.

Conclusions and implications: Findings describe the criteria currently in use for palliative care referral and barriers to palliative care provision for nursing home residents. Findings suggest that both education about palliative care and defined criteria are needed to facilitate timely entry into primary and specialty palliative care programs.

Learner outcome: Enhance the learners’ knowledge of palliative care referral criteria for use with nursing home residents and understanding of primary palliative care as one strategy to improve nursing home resident quality of life.